Insurance, my DME, and S9

[Satsleep]

My DME was all set to furnish me an S8 Autoset II. He said my insurance would pay a rental fee for 10 to 13 months and I would be responsible for a small copay until the rental period ended and then the insurance would buy the machine for me and I would have no additional cost. He said that since all machines are coded the same it does not matter whether I went with an inexpensive CPAP or the more expensive S8 APAP as there would be no difference in what the insurance and I paid for rental. It would seem that the cheaper machine the DME put a patient in the more profit they make as they get the same income. But as to the insurance company they would not care which machine I received because their cost is the same.

Today we started talking about the new S9 and my DME has reached out to his distributor to find out how much it will cost and when it will be available in our area. He stated there might be a problem with my insurance if it cost too much more than an S8. Does this make sense? If all the machines are coded the same and the DME will be paid the same for an S8 as they would for a inexpensive machine then why does it matter to the insurance? Is his real concern what is it going to do to his profit? I hope some of you who understand how the insurance works will weigh in on this.

Larry

[jules]

Suppose he gets $500 for the machine from insurance - that amount is fixed, but it costs him $496 wholesale for the S9 and only $420 wholesale for the S8, ........

now what would you do?

He sounds willing to take a cut to satisfy you but how much cut should he take?

What if it costs him $ 523 to get the S9 but your particular insurance still will only pay him $ 500?

[Muse-Inc]

I'm sure the S9 models will cost more than the S8 models. As for the small co-pay, it might not be so small...my co-pay for a 10-month lease was $890 for a machine that likely only cost $350 at the time if I bought it from our host https://www.cpap.com. Sometimes, it's jsut worth it to buy it outright...see if your insurance will re-imburse you if you buy it online.

[rested gal]

I would choose the ResMed S8 Autoset II over the newer S9 model. But that's just my opinion.

[dtsm]

I luv new toys but prefer true and tested models for therapy

[Satsleep]

Suppose he gets $500 for the machine from insurance - that amount is fixed, but it costs him $496 wholesale for the S9 and only $420 wholesale for the S8, ........

now what would you do?

He sounds willing to take a cut to satisfy you but how much cut should he take?

What if it costs him $ 523 to get the S9 but your particular insurance still will only pay him $ 500?

Jules, This is what I think is the case. The insurance will pay him the same for the S8 and the S9, but he will make more profit on the S8. Although that is not what he is saying. He said if there is a problem it will be with the insurance company. Is he being honest or is he just blaming the insurance company instead of saying he will not make enough profit? Of course this is still hypothetical because I do not know if there will be a problem.

Larry

[Satsleep]

Rested Gal and DTSM, Why would you choose the S8 over the S9? Is it because you do not like the features or is there a therapeutic reason?

Larry

[jules]

each insurance company pays differently - some companies might pay him $750 when your insurance will only give him $500 for the same machine

he is going to only offer that new S9 to those that pay better than yours - in this way it is the insurance's fault as they aren't giving him enough to give you the "best" machine and this happens all the time too

I go in with insurance X and I can get whatever the script says but Joe goes in say on medicaid and all he can get is a basic DS100

[jnk]

I would choose the ResMed S8 Autoset II over the newer S9 model. But that's just my opinion.

Mine, too.

[dsm]

Rested Gal and DTSM, Why would you choose the S8 over the S9? Is it because you do not like the features or is there a therapeutic reason?

Larry

I'd love to see an honest answer to that too

DSM

[ozij]

I would discuss a rental to try out any automatic machine before I made a decision to buy.

[dtsm]

Rested Gal and DTSM, Why would you choose the S8 over the S9? Is it because you do not like the features or is there a therapeutic reason?

Larry

I'd love to see an honest answer to that too

DSM

I got the S8 after research here on this forum and reading the wiki and words of wisdom. And consulting with the sleep center. The DME had absolutely no input, they just complied with my request.

I'm lucky, no co-pay for anything. I get replenishment every 3 months - hose, mask, filters. My insurance pays for the S8 - they say it's on a rental basis btwn them and DME. If I wanted to, could ask to swap my S8 for a new 9. But why do that if the S8 works....so far no complaints. I'm a newbie n still learning but my numbers are improving, I'm patient and know this is a marathon.

Knowing what little I know about the 9 it sounds like a great sexy new unit, but personally I'd wait to hear what you all in the forum have to say before considering it. If I had to do it today, would still opt for the S8.

That's the honest answer :

[dsm]

dtsm

I sold my S8 Spirit a few months ago knowing the S9 was coming but it is the
S8 I like for travel. Best travel machine I ever owned - used to have an S8
Escape before the S8 Spirit - I am hoping there will be a few S8 Autoset IIs
available at unheard of low prices soon

DSM

[DreamOn]

I am hoping there will be a few S8 Autoset IIs available at unheard of low prices soon

Me too!!!

[Slinky]

If they S8 II owners are smart there won't be.